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Get Out—and Don't Come Back

May 10, 2009
by daphne
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The last time my mom got out the hospital, she really had no idea what she was supposed to do. And of course she lost the instruction sheet they gave her.

Still, she was one of the lucky ones—she managed to stay out of the hospital. Too many patients are readmitted a week after their stay, when some simple follow up care could have prevented that readmission. We all know there’s something wrong with this picture.

Like most things, it comes down to the money.

When I was at HIMSS, it seemed there were a lot more people touting solutions like education modules, telehealth follows ups and monitoring. I started thinking about the rise of post discharge care as a trend. But here’s the question: Who’s paying?

Running these programs costs money, from the IT solutions to the nurses that monitor them. Again, who’s paying? Insurers typically don’t reimburse for the follow up. So not only are the hospitals spending money on providing the care, they’re losing the revenue of an expensive admission. Bad in good times, even worse in times like these.

I’ve seen firsthand that these solutions, particularly for chronic conditions like CHF, can improve lives and keep patients home. Years ago, I worked for a very highly rated heart hospital, with an amazing post-discharge follow up program, with an entire building devoted to post discharge care. BUT. This was one of the most heavily endowed hospitals in the country, with a stellar donor list and deep, deep coffers.

Sure, the program worked there. But you’re not that hospital, and you don’t have that kind of money.

There’s a little bit of panic starting about Washington’s buzz to reduce Medicare payments to hospitals with the highest re-admission rates. As many hospital administrators will say, “I can’t help it if they don’t take their medicine when they get home.”

But maybe it’s our job to make sure they do. Bundling payments by insurers to include post discharge care in a hospitalization would be a good place to start, I think.

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